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Evaluation of clinical outcomes

of neonates born to mothers with
Website:
coronavirus (COVID‑19) in Shahid
Beheshti Hospitals
www.jehp.net

DOI:
10.4103/jehp.jehp_20_21
Maryam Sadat Hosseini1, Afsaneh Hosseini1, Elnaz Ghaffari1, Mitra Radfar3,
Fariba Shirvani3, Shahrzad Tabatabai4, Dariush Abtahi5, Mahsa Mirhadi1,
Maziyar Mortazavi6, Shideh Ariana1,2
1
Preventative Gynecology
Research Center, Shahid
Abstract:
Beheshti University
of Medical Sciences, BACKGROUND: The coronavirus, which is caused by acute respiratory syndrome, appeared in
Tehran, Iran, 3Pediatric Wuhan, China, in December 2019 and gradually spread around the world until almost all countries
Infections Research became infected with the coronavirus. In Iran, the outbreak of coronavirus began on February 21,
Center, Research 2020, with the report of infection of two people in the city of Qom. The aim of this study is to evaluate
Institute for Children the clinical findings of neonates born to pregnant women with corona disease.
Health, Shahid Beheshti MATERIALS AND METHODS: During this case study (February 21 to November 30, 2020), out of
University of Medical 88 pregnant mothers who referred to the hospitals of Shahid Beheshti University of Medical Sciences,
Sciences, Tehran, Iran, 44 live neonates were born from 42 pregnant women with COVID‑19, who were evaluated for clinical
4
Department of Pediatric, signs by studying their files and reported as a case series, due to limited samples, No statistical
Shahid Beheshti University analysis of the study was performed.
of Medical Sciences, RESULTS: In studies of clinical records of hospitalized mothers and infants, among the polymerase
Tehran, Iran, 5Department chain reactions (PCRs) provided for all infants, one PCR was reported positive 2 days after birth,
of Anesthesiology, whereas this infant 10 min after birth, immediately after routine procedures, due to positive mother’s
Imam Hossein General PCR was isolated from the operating room. However, all of the infant’s clinical symptoms were normal
Hospital, Shahid Beheshti during the 3‑day hospital stay for routine postpartum care. Twenty‑eight days after birth, the baby
University of Medical was reevaluated for clinical, laboratory, and chest X‑ray symptoms, all of which were normal. The
Science, Tehran, Iran, PCR of other neonates was negative, and five intubated neonates, two twin, and two single died, and
6
Department of Pediatric, the other neonates were discharged. In evaluating the clinical records of mothers of these infants,
Sarem Hospital, Tehran, the mean age is 30 years, and the average gestational age is 35 weeks, 32 cases of caesarean
Iran, 2Department section, and 10 cases of normal delivery.
of Obstetrics and
CONCLUSION: We describe epidemiological data, demographics, signs and symptoms on
Gynecology, Perinatology
admission, laboratory results, comorbidities, infection COVID‑19 in the mothers and neonates,
Division, Imam Hossein
chest radiography and computed tomography findings, treatment received for COVID‑19, and
Medical Center, School of
clinical maternal, fetal, and neonatal outcomes. Due to the fact that the study population is
Medicine, Shahid Beheshti
small consist of 42 mothers with COVID‑19 infection, among all PCR samples from infants
University of Medical
born to COVID‑19 positive mothers, the PCR result of one case was positive, and the rest of
Sciences, Tehran, Iran
was negative. Therefore, vertical transmission of COVID‑19 through the placenta to the fetus
Address for cannot be confirmed or denied, nor can the COVID‑19 confirmed or denied the baby’s postnatal
correspondence: complication during pregnancy.
Dr. Shideh Ariana, Keywords:
Department of Obstetrics
and Gynecology, Coronavirus, COVID‑19, infant, pregnancy
Perinatology Division,
Imam Hossein Medical
Center, School of
Medicine, Shahid Beheshti
University of Medical
This is an open access journal, and articles are
Sciences, Tehran, Iran. distributed under the terms of the Creative Commons
E‑mail: shideh.ryn23@ Attribution‑NonCommercial‑ShareAlike 4.0 License, which How to cite this article: Hosseini MS, Hosseini A,
yahoo.com allows others to remix, tweak, and build upon the work Ghaffari E, Radfar M, Shirvani F, Tabatabai S, et al.
non‑commercially, as long as appropriate credit is given and Evaluation of clinical outcomes of neonates born to
Received: 04‑01‑2021 mothers with coronavirus (COVID-19) in Shahid
the new creations are licensed under the identical terms.
Accepted: 22‑01‑2021 Beheshti Hospitals. J Edu Health Promot 2021;10:173.
Published: 31-05-2021 For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

© 2021 Journal of Education and Health Promotion | Published by Wolters Kluwer - Medknow 1
 Hosseini, et al.: Evalution of infants born to mothers with COVID‑19
Introduction
C oronaviruses are large groups of viruses that can
infect animals and humans and cause respiratory
problems. These problems can be as mild as a cold or as
severe as pneumonia. COVID‑19 is a type of coronavirus
that was first identified in Wuhan, Hubei Province, China
in late 2019, where it has become widespread and has
become a global epidemic. Complications of this new type
of corona in patients may include fever, chills, and runny
nose. Shortness of breath and more severe cases of this
type of infection can cause severe and acute respiratory
problems.[1] Due to the coronavirus epidemic, pregnant
mothers due to physiological, anatomical, and hormonal
changes during pregnancy and the susceptibility of
pregnant women to infection various diseases, this
study is to find the relationship between coronavirus
disease in the mother and complication’s Clinically in
mother and infant. On the other hand, mechanical and
biochemical factors affect gas exchange and pulmonary
function during pregnancy and reduce functional
residual capacity and residual volume during pregnancy.
For this reason, there are concerns about the serious
consequences of the coronavirus epidemic for pregnant
women[2] and its effect on the infant.[3] In pregnant
women with COVID‑19, hypertensive disorders and
diabetes are common comorbidities is a risk of preterm
delivery and maternal death, among the neonates
born to mothers with COVID‑19, respiratory distress
syndrome, and pneumonia are common occurrence,
there are reports of still births and neonatal deaths
also there is an evidence of vertical transmission of
SARS‑COV‑2 infection in women with COVID‑19.[4]
Therefore, appropriate prevention and treatment used by
the general public may not be effective and appropriate
for pregnant women.[5] As a result of the transmission
of the disease from an infected mother to the infant, we
have examined that, because the incidence of COVID‑19
is increasing in pregnant women. According to a case
study by Wang et al., in December 2019, on a mother with
COVID‑19, the clinical data of this infection in infants
are very limited, and the vertical transmission of the
infection from mother to fetus through the placenta is
unclear, so all suspected mothers and their infants should
have diagnostic tests for this infection.[6] According to a
study by Yu et al. In December 2019 on 7 pregnant women
with COVID‑19, three of whom were primiparous and
four were multiparous; the clinical and gynecological
characteristics and outcomes of their infants were
studied. In the evaluation, all of these mothers were
treated and discharged from the hospital, and all their
clinical symptoms improved. The infants born to these
mothers had Apgar and normal weight, four infants were
cared for at home and a diagnostic test (COVID‑19) was
not performed. They did not have any clinical signs of
high fever or other symptoms during follow‑up 28 days
2 Journal of Education and Health Promotion | Volume 10 | May 2021
after birth. Moreover, three other neonates were cared for
in the neonatal ward in hospital and were sent for them
a diagnostic nucleic acid test. One of the three neonates
was tested positive for nucleic acid, and the other two
were negative. After admission, these neonates did not
have fever and cough but symptoms of brief shortness of
breath was reported doing chest X-ray (CXR) revealed a
brief pulmonary infection. These infants were reported
healthy 28 days after birth and showed no signs of
breathing problems or fever.[7] Currently, there is no
clear evidence regarding optimal delivery timing, the
safety of vaginal delivery, or whether cesarean delivery
prevents vertical transmission at the time of delivery;
therefore, route of delivery and delivery timing should
be individualized based on obstetrical indications
and maternal–fetal status.[8] Under the premise of full
evaluation of vaginal delivery conditions and strict
protection measures, pregnant women with ordinary
type COVID-19 can try vaginal delivery without
exacerbation of COVID-19 and without increasing the
risk of SARS-CoV-2 infection in neonates.[9] During
this study (February 21 to November 30, 2020), out of
88 pregnant mothers who referred to the hospitals of
Tehran Shahid Beheshti University of Medical Sciences,
44 live neonates were born from 42 pregnant women
with COVID-19, who were evaluated for clinical signs
by studying their files. There is currently no definitive
information on the epidemiology and clinical features
of COVID-19-induced pneumonia and its treatment
experience in pregnancy. The aim of this study is to
describe the epidemiological features, clinical, laboratory,
radiological, and treatment outcomes of neonates born
to pregnant women with COVID-19. In this study,
maternal and neonatal demographic factors including
maternal age, number of pregnancies, gestational age,
multiple births, sex, neonatal weight, and duration of
maternal coronavirus infection until delivery and clinical
signs of mother and fetus including fever, lethargy,
headache, tachypnea, tachycardia, respiratory distress,
fetal distress, placental abruption, PPROM, preterm
labor, and history of underlying diseases in the mother
including preeclampsia, hypothyroidism, RH negative
and receiving Rhogam, thrombocytopenia, liver disease,
diabetes and drug history, infertility and infertility
treatment (IVF), three medications for pre- and post-
partum coronavirus infection, receiving betamethasone
during pregnancy, and any history of surgery in the
mother and type of delivery, and any drug treatment in
the newborn including resuscitation at birth, receiving
surfactant, receiving epinephrine, antibiotic treatment,
phototherapy, receiving blood and blood products,
oxygen therapy, intubation, as well as diagnostic
procedures in mother and infant including polymerase
chain reaction (PCR) test, complete blood count (CBC)
tests/erythrocyte sedimentation rate (ESR)/C-reactive
protein (CRP), and Arterial Blood Gas (ABG), Venous
 Hosseini, et al.: Evalution of infants born to mothers with COVID‑19
Blood Gas (VBG) cord blood samples, and paraclinical
procedures including computed tomography (CT) scan,
CXR, and ultrasound.
Materials and Methods
Study sampling
This retrospective study with the participation of 44
live neonates were born from 42 pregnant women with
COVID‑19, who were evaluated for clinical signs by
studying their files and reported as a case series was
conducted from February 21 to November 30, 2020. Our
Sample size was all pregnant women with COVID‑19
who were hospitalized by studying their clinical records,
in during this study, That were randomly selected and
in terms of clinical features, treatment and neonatal
outcomes, epidemiological factors, demographics,
clinical signs, laboratory, radiography, delivery method,
and maternal medical records were evaluated by studying
the clinical records of mothers and infants. Newborns
born to mothers with coronavirus immediately after
birth they were transferred to the neonatal ward in
isolation to evaluation clinical signs and perform a
PCR test to confirm or rule out COVID‑19 infection.
During this study, out of 88 pregnant mothers who
referred to the hospitals of Shahid Beheshti University
of Medical Sciences in Tehran, 44 live neonates were
born to 42 pregnant women with COVID‑19 who were
evaluated for clinical symptoms and reported. data of
42 pregnant women and their neonates was completed
in researcher‑made questionnaire after confirming
informed consent form.also This retrospective study was
approved by the Shahid Beheshti University of Medical
Sciences by ethical committee (IR.SBMU.RETECH.
REC.1399.663).
Data analysis
Due to limited samples, no statistical analysis of the
study was performed. Results of clinical features of
pregnant women with COVID‑19 , information on their
newborns and their Pathogen identification results was
reported directly.
Results
In evaluation of clinical outcomes of neonates born
to mothers with coronavirus (COVID‑19) in Shahid
Beheshti hospitals, clinical features of prenatal mothers
with COVID‑19 showed that the symptoms of COVID‑19
involvement were present before delivery and the
duration of symptoms until delivery varied from 2 days
to 3 weeks, and mothers underwent azithromycin, oral
oseltamivir, hydroxychloroquine, and ceftriaxone were
injected. Drug therapy was started before delivery and
continued after delivery. After diagnosis by laboratory
methods (CBC, ESR, CRP, and PCR) and paraclinical
Journal of Education and Health Promotion | Volume 10 | May 2021
(CT and CXR), these women showed mild‑to‑ severe
symptoms of coronavirus disease, which led to the
hospitalization of six patients in the intensive care unit.
Among pregnant women with coronavirus disease,
32 had cesarean section and 10 had normal delivery,
of which two mothers died and 40 were treated and
discharged. Infants born to pregnant women showed
the following symptoms: one case of placental abruption,
6 case of fetal distress, one case of Intra Utrine Growth
Restrition (IUGR), 7 cases of ruptured amniotic fluid,
one case of abnormal amniotic fluid (meconium), five
cases of respiratory distress, and one case organ cyanosis,
13 cases of Apgar 8 and below 8, two of which died
immediately after birth and three during hospitalization.
Discussion
According to a study by Schwartz in April 2020, which
analyzed 38 pregnant women with (COVID‑19) and their
newborns and methods of transmitting the infection and
their pregnancy outcome, the presence of this infection
in one of the infants 17 days later from birth and in
another infant 36 h after delivery. It was confirmed
that, in both cases, there was no direct evidence that
the transfer was vertical.[10] According to a February
2020 study by Zhu et al., on 10 infants (one twins) out of
nine mothers with COVID‑19 factors such as gestational
age, the 1st and 5th min Apgar scores, sex, birth weight,
singleton or multiple births, AGA (suitable infant For
reproductive age), primary symptoms, other secondary
symptoms, blood product intake, and its complications
were evaluated. Therefore, according to this study, in
infants of corona‑positive mothers may have symptoms
such as: fetal distress/respiratory distress/preterm
labor/thrombocytopenia.[11] According to the study of
Karimi‑Zarchi et al., in April 2020 on three infants born to
mothers with COVID‑19, there has been limited evidence
for vertical transmission (COVID‑19) from mothers with
fetuses.[12] According to a study by Lu and Shi conceived
this review, COVID-19 can result in asymptomatic to
severe illness; fortunately, children without underlying
diseases appeared to have mild disease. The disease
condition of the neonates was also minor. Although this
new virus comes out without specific antiviral drugs
treatment, neonatologist needs to more virological,
epidemiological, and clinical data to treat and manage
COVID-19.[13] The first published paediatric studies with
data of case series in China described an incidence in
children ranging from 0.8% to 2% of the total reported
cases, with a milder disease course compared to adults
and a predominance of respiratory symptoms. [14]
To a study by Liu et al., the aim of this study was to
investigate the clinical characteristics of neonates born to
SARS‑CoV‑2‑infected mothers and increase the current
knowledge on the perinatal consequences of COVID‑19.
Nineteen neonates were admitted to Tongji Hospital
3
 Hosseini, et al.: Evalution of infants born to mothers with COVID‑19
from January 31 to February 29, 2020. Their mothers
were clinically diagnosed or laboratory confirmed
with COVID‑19. There are 19 neonates included in the
research. Among them, ten mothers were confirmed
COVID‑19 by positive SARS‑CoV‑2 RT‑PCR in throat
swab, and 9 mothers were clinically diagnosed with
COVID‑19. Delivery occurred in an isolation room, and
neonates were immediately separated from the mothers
and isolated for at least 14 days. No fetal distress was
found. SARS‑CoV‑2 RT‑PCR in throat swab, urine, and
faces of all neonates were negative. The delivery should
occur in isolation, and neonates should be separated from
the infected mothers and caregivers.[15] The risk of vertical
and perinatal transmission of severe acute respiratory
syndrome coronavirus 2 (SARS‑CoV‑2, which causes
COVID‑19), the most appropriate management, and
the neonate’s risk of developing COVID‑19 during
the perinatal period are unknown.[16] Person‑to‑person
transmission of SARS‑CoV‑2 has been confirmed
by epidemiological studies of cases associated with
COVID‑19.[17] However, a previous study showed that
there were no clinical findings suggestive of COVID‑19
in 19 neonates born to infected mothers, and all samples
including nasopharyngeal and rectal swabs from
neonates, amniotic fluid, cord blood, and breastmilk were
detected negative for SARS‑CoV‑2.[11,18] According to a
study by Karimi‑Zarchi, a total of 31 infected pregnant
mothers with COVID‑19 were reported. No COVID‑19
infection was detected in their neonates or placentas.[12]
Therefore, the criterion may need to be revised based
on the available data. Currently, no evidences have
shown that the SARS‑CoV‑2 can be transmitted from
neonates to other neonates or to caregivers or health‑care
workers. Importantly, as the possibility of fecal–oral
transmission exists, the appropriate education should
be offered to parents with respect to hand hygiene and
disinfection of children’s excreta at home.[19] The most
common manifestations of COVID‑19 consist of fever,
cough, and fatigue or myalgia, sputum production, and
headache.[20,21] As COVID‑19 virus is still spreading,
more infections in pregnant women are likely to be seen.
Whether COVID‑19 increases, the risk of miscarriage,
stillbirth, preterm delivery, fetal tachycardia, and fetal
distress is unknown. According to the official website
of the Ministry of Health and Medical Education in
Mazandaran and Zanjan provinces, Iran, three infants
were born from infected pregnant mothers. Among
these three cases of COVID‑19 infection, there were
two mothers who developed acute respiratory distress
syndrome after delivery and died. According to the
websites, their neonates were negative when tested
for COVID‑19. [22] Limited information is available
on pregnant women with COVID-19, but pregnant
women may be more susceptible to viral respiratory
infections including COVID-19, due to immunological
and physiological changes. Therefore, pregnant women
4 Journal of Education and Health Promotion | Volume 10 | May 2021
should take routine preventive measures, such as
washing their hands frequently and avoiding contact
with infected people, to prevent infection.[23] On the
other hand, the optimal management strategy to prevent
thrombosis in critically‑ill patients with COVID‑19
remains unknown.[24]
Results of clinical features of pregnant women
with COVID‑19
Mothers infected with the coronavirus had a mean age
of 30 years (17–48) with a gestational age of 25–40 weeks
and 1 day. Ten cases of labor pain, one case of vaginal
bleeding (placental abruption), nine case of fever, five
cases of premature rupture of the amniotic sac, one case
of meconium tics, 42 cases of singleton, and two case
of twins, 32 cases of cesarean section, and ten cases of
normal delivery, one case of history infertility, and the
use of assisted reproductive techniques, received four
cases of preeclampsia. Two cases of glass addiction, three
cases of hypothyroidism, one case of fatty liver, two cases
of received blood products, six cases of hospitalization
in intensive care unit, two cases of negative blood group
with receive Rhogam, one deaths, 41 were treated and
discharged, one was a heart problem, and four were
intubations [Table 1].
Information on newborns born to mothers with
COVID‑19
Among the infants born to mothers with coronavirus
disease, 26 were term and 18 were premature, 26 were
male, 18 were female, 2 was twin, 40 were single,
31 had an Apgar score of 9/10, and two had 1/0, seven
8/10, one case 2/10, and 3 case 7/10. Thirty‑nine cases
normalization saturation and five cases abnormal, ten
cases of respiratory problems, and three cases of low BS,
one case of intolerance to nutrition, from radiographs
were performed, and two were abnormal, one case
received positive PCR result, three cases received blood
products, two cases of cyanotic organs at birth, 22 cases
were admitted to NICU due to preterm and unstable
clinical condition after birth, three cases received
surfactant, five cases were intubated immediately after
birth, six cases received adjacent oxygen, result of ABG
VBG of umbilical cord of five case were abnormal infants,
seven infants died, eight cases underwent phototherapy,
39 cases were treated and discharged [Table 2].
Pathogen identification results
All patients admitted as suspected coronavirus, results
of PCR and CT showed COVID‑19 infection. The
results of the infection were severe in the mother one of
twins and two cases of singleton (one case of placental
abruption); finally, the mother of twins and another
mother died, and the other mother was treated and
discharged. Moreover, finally (one of the twins died
2 days and the other 5 days after birth due to preterm
 Hosseini, et al.: Evalution of infants born to mothers with COVID‑19

Table 1: Mothers information

Case Age First symptom Delivery mode Outcome
1 35 Cough, tachypnea C/S Cured
2 32 Cough, tachypnea C/S Cured
3 23 Cough, tachypnea C/S Cured
4 32 Cough, tachypnea C/S Cured
5 26 Cough, tachypnea C/S Cured
6 20 Cough, tachypnea NVD Cured
7 41 Cough, tachypnea C/S Died
8 32 Cough, tachypnea NVD Cured
9 35 Cough, tachypnea C/S Cured
10 20 Fever, tachypnea, cough C/S Cured
11 29 Cough, fever NVD Cured
12 36 Cough, fever C/S Cured
13 26 Skin itching, hyperbilirubinemia C/S Cured
14 48 Cough, fever C/S Died
15 23 Cough, tachypnea, fever C/S Cured
16 32 Cough, tachypnea, dyspnea C/S Cured
17 20 Fever, tachypnea, cough NVD Cured
18 31 Cough, body pain C/S Cured
19 30 No C/S Cured
20 30 Cough, tachypnea, headach C/S Cured
21 34 Fever, pain body C/S Cured
22 37 Cough, pain body NVD Cured
23 24 No NVD Cured
24 24 Cough/tachypnea/dyspnea C/S Cured
25 39 No C/S Cured
26 33 No C/S Cured
27 34 Cough NVD Cured
28 37 Hyperbilirubinemia, skin itching, runny nos C/S Cured
29 22 Cough, fever C/S Cured
30 22 Cough, fever NVD Cured
31 37 Cough, fever C/S Cured
32 32 Cough, tachypnea, dyspnea C/S Cured
33 32 No C/S Cured
34 25 No C/S Cured
35 26 No C/S Cured
36 24 Cough, tachypnea, vomit, nausea, epigastric pain C/S Cured
37 20 Dyspnea, shiver, sweating C/S Cured
38 39 Tachypnea C/S Cured
39 17 Labor pain NVD Cured
40 37 No C/S Cured
41 21 BPP=4/8 NVD Cured
42 39 No C/S Cured
BPP=Biophysical profile, NVD=Normal vaginal delivery, C/S=Cesarean Section

Table 2: Neonates information

Case Gestational age Birth weight (g) Pregnancy Apgar Score 1-min Apgar Score 5-min First symptom Outcome
1 37 weeks 2020 Singleton 9 10 No Cured
2 39 weeks 3500 Singleton 9 10 No Cured
3 38 weeks 3300 Singleton 9 10 RDS/grunting Cured
4 36 weeks 3200 Singleton 9 10 No Cured
5 33 weeks 2100 Singleton 9 10 No Cured
6 36 weeks 2415 Singleton 9 10 No Cured
7 28 weeks, 1 day 870 Singleton 1 0 RDS Died
8 36 weeks, 6 days 2640 Singleton 9 10 Grunting Cured
9 34 weeks, 6 days 4050 Singleton 9 10 RDS/acrocyanosis Cured

Contd...
Journal of Education and Health Promotion | Volume 10 | May 2021 5
 Hosseini, et al.: Evalution of infants born to mothers with COVID‑19

Table 2: Contd...
Case Gestational age Birth weight (g) Pregnancy Apgar Score 1-min Apgar Score 5-min First symptom Outcome
10 39 weeks, 6 days 3300 Singleton 9 10 No Cured
11 40 weeks, 1 days 3500 Singleton 9 10 No Cured
12 39 weeks 1070 Singleton 9 10 No Cured
13 27 weeks, 6 days 1210 Singleton 8 10 RDS/shortness of breath Died
14 28 weeks, 2 days 1300 Twin 2 10 RDS/shortness of breath Died
15 37 weeks, 5 days 3165 Twin 7 10 RDS/shortness of breath Died
16 37 weeks 3000 Singleton 8 10 Acrocyanosis Cured
17 40 weeks 3000 Singleton 9 10 No Cured
18 36 weeks, 6 days 2000 Singleton 8 10 No Cured
19 36 weeks, 6 days 3720 Singleton 9 10 No Cured
20 34 weeks 2100 Singleton 9 10 No Cured
21 34 weeks 2415 Twin 8 9 RDS/grunting Cured
22 32 weeks 2200 Twin 8 9 RDS/grunting Cured
23 40 weeks, 6 days 4300 Singleton 9 10 No Cured
24 40 weeks 3150 Singleton 9 10 No Cured
25 41 weeks 3300 Singleton 9 10 No Cured
26 40 weeks 3200 Singleton 9 10 No Cured
27 32 weeks 2100 Singleton 9 10 RDS Cured
28 33 weeks 1650 Singleton 9 10 No Cured
29 32 weeks 2900 Singleton 9 10 No Cured
30 37 weeks 650 Singleton 9 10 No Cured
31 25 weeks 3275 Singleton 1 0 No Died
32 37 weeks 3235 Singleton 9 10 No Cured
33 34 weeks 2500 Singleton 9 10 No Cured
34 38 weeks 2600 Singleton 8 10 No Cured
35 40 weeks 3600 Singleton 9 10 No Cured
36 32 weeks 2340 Singleton 9 10 No Cured
37 32 weeks, 3 days 2500 Singleton 8 9 RDS/grunting Cured
38 38 weeks, 4 days 2950 Singleton 9 10 No Cured
39 32 weeks 1525 Singleton 7 10 No Cured
40 39 weeks 3345 Singleton 9 10 No Cured
41 38 weeks, 5 days 33350 Singleton 9 10 No Cured
42 40 weeks, 4 days 3500 Singleton 7 9 No Cured
43 37 weeks, 5 days 3355 Singleton 9 10 No Cured
44 33 weeks 2100 Singleton 9 10 No Cured
RDS=Respiratory distress syndrome

Table 3: Pathogen identification results

Case Specimen Result (mothers) Result (neonates) CT (mothers) CXR (neonates)
1 Throat swab (+) (+) (+) None
2 Throat swab (+) (_) (+) None
3 Throat swab (+) (_) (+) None
4 Throat swab (+) (_) (+) None
5 Throat swab (+) (_) (+) None
6 Throat swab (+) (_) (+) (_)
7 Throat swab (+) (_) (+) (_)
8 Throat swab (+) (_) (+) None
9 Throat swab (+) (_) (+) None
10 Throat swab (+) (_) (+) None
11 Throat swab (+) (_) (+) None
12 Throat swab (+) (_) (+) None
13 Throat swab (+) (_) (+) None
(Twins mother) 14 Throat swab (+) (_) (+) (_)
(Twins mother) 15 Throat swab (+) (_) (+) (_)
16 Throat swab (+) (_) (_) (_)

Contd...
6 Journal of Education and Health Promotion | Volume 10 | May 2021
 Hosseini, et al.: Evalution of infants born to mothers with COVID‑19

Table 3: Contd...
Case Specimen Result (mothers) Result (neonates) CT (mothers) CXR (neonates)
18 Throat swab (+) (_) (_) (_)
19 Throat swab (+) (_) (+) None
20 Throat swab (+) (_) (+) None
(Twins mother) 21 Throat swab (+) (_) (_) None
(Twins mother) 22 Throat swab (+) (_) (+) None
23 Throat swab (+) (_) (+) None
24 Throat swab (+) (_) (+) (_)
25 Throat swab (+) (_) (_) (_)
26 Throat swab (+) (_) (+) (_)
27 Throat swab (+) (_) (_) (_)
28 Throat swab (+) (_) (_) (_)
29 Throat swab (+) (_) (_) (_)
30 Throat swab (+) (_) (+) (_)
31 Throat swab (+) (_) (_) None
32 Throat swab (+) (_) (+) None
33 Throat swab (+) (_) (+) None
34 Throat swab (+) (_) (+) (_)
35 Throat swab (+) (_) (+) (_)
36 Throat swab (+) (_) (+) (_)
37 Throat swab (+) (_) (+) (_)
38 Throat swab (+) (_) (+) (_)
39 Throat swab (+) (_) (+) (_)
40 Throat swab (+) (_) (+) (_)
41 Throat swab (+) (_) (_) (_)
42 Throat swab (+) (_) (+) (_)
43 Throat swab (+) (_) (+) (_)
44 Throat swab (+) (_) (+) (_)
CT=Computed tomography, CXR=Chest X‑ray ,(_) Normal result ,(+) Abnormal result

Figure 1: Chest X‑ray 13 neonates

Journal of Education and Health Promotion | Volume 10 | May 2021 7

 Hosseini, et al.: Evalution of infants born to mothers with COVID‑19
birth and lung bleeding) and the other newborn, which
was the result of emergency cesarean section due to
breech and placental abruption, immediately 1 minute
after birth in the operating room died with Apgar 1/0,
and the mother suffered a cardiac arrest and intubation
due to severe infection and unstable blood pressure
during cesarean section was transferred to ICU after
cesarean section and less than 12 h after delivery due to
cardiac arrest and severe infection died. According to the
PCR sample of infants, a positive case has been reported,
and this infant was admitted to the isolated ward 10 min
after birth to perform the necessary examinations and
was discharged in good general condition 3 days after
birth and did not receive any viral treatment. CXR was
not performed for the infant at the time of admission.
On examination and CXR performed 28 days after birth,
all clinical signs of neonatal and normal CXR were
reported, from other infants normal CXR were reported
[Figure 1 and Table 3].
Conclusion
We describe epidemiological data, demographics,
signs and symptoms on admission, laboratory results,
comorbidities, infection COVID‑19 in the mothers and
neonates, chest radiography and CT findings, treatment
received for COVID‑19, and clinical maternal, and fetal
and neonatal outcomes. Due to the fact that the study
population is small consist of 42 mothers with COVID‑19
infection, among all PCRs samples from infants born to
COVID‑19‑positive mothers, the PCR result of one case
was positive, and the rest of was negative. Therefore,
vertical transmission of COVID‑19 through the placenta
to the fetus cannot be confirmed or denied, nor can the
virus corona confirmed or denied the baby’s postnatal
complication during pregnancy.
Acknowledgment
The authors wish to express their thanks to all the
mothers who participated in the present research.
This study was approved by the Shahid Beheshti
University of Medical Sciences by ethical committee
(IR.SBMU.RETECH.REC.1399.663).
Financial support and sponsorship
The present study was funded by Preventative
Gynecology Research Center, Shahid Beheshti University
of Medical Sciences, Tehran, Iran.
Conflicts of interest
There are no conflicts of interest.
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